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Each death from Covid-19 prevented by stopping vaccination campaigns in Africa could result in, on average, 139 preventable deaths. Tens of thousands of children around the world, and on this continent more than elsewhere, are on the brink of failure to have been vaccinated. This is what is expected from a modeling of the London School of Hygiene and Tropical Medicine carried out in May and discussed during exchanges with researchers from the British institution during World Day of the African Child, Tuesday 16 June.
At a time when Africa passed, that same day, the milestone of 250,000 contaminations with the new coronavirus and recorded nearly 7,000 deaths, the vaccination of millions of children against several childhood diseases is lagging behind that could be fatal to many of them in the near future.
Measles, rubella, diphtheria, tetanus, pneumococci, whooping cough, yellow fever, many other viruses than SARS-CoV-2 circulate, which still kill 1.5 million people worldwide every year despite the existence of vaccines. The African continent still had nearly 8.5 million children under-vaccinated in 2018, according to the Gavi Vaccine Alliance.
In a few weeks, the coronavirus pandemic has accelerated this delay and jeopardized two decades of spectacular progress in terms of vaccinations. The shutdown of more than half of humanity, at the height of the crisis, indeed seriously jeopardized mass campaigns and greatly disrupted routine vaccination which is carried out over the long term in health centers. community health, schools or hospitals.
Maintain routine immunization
Already in mid-April the Measles and Rubella Initiative – which brings together major global players such as the World Health Organization (WHO) and Unicef - alerted world opinion: 117 million children, including more than two-thirds less than a year old, were at risk of not being vaccinated against measles due to the interruption of major preventive vaccination operations in 37 countries, in order to halt the spread of the virus responsible for Covid- 19. A “Dizzying figure which does not take into account the number of infants at risk of not being vaccinated in the centers which provide vaccination” routine, clarified the press release.
In Africa, 21 million children under the age of 5 in six countries were expected to benefit from mass prevention or a response to an ongoing epidemic between February and April. While South Sudan, the Central African Republic and the Democratic Republic of the Congo (DRC) succeeded in carrying out their campaign despite the insecurity and the difficulties, Chad, for its part, succeeded only partially, while Nigeria and Ethiopia, the continent’s two demographic heavyweights, had to postpone theirs.
“As early as the end of March, after African countries began to be seriously affected by Covid-19, WHO met to take stock of what was happening, says Dr. Richard Mihigo, regional coordinator of the WHO immunization and vaccine development program for Africa, based in Brazzaville, Republic of the Congo. We had known the precedent of the Ebola crisis in West Africa from 2013-2014. This epidemic episode had already had consequences on the vaccinations in progress and enabled us to anticipate the difficulties. “
Faced with this new enemy, the recommendations of the UN institution are clear: countries which are not immediately exposed to the epidemic must “Temporarily postpone major prevention campaigns”, but maintain routine immunization as much as possible. As the countries are sovereign in these decisions, each has made its choice in the light of its situation and its means.
Suspicion of serving as guinea pigs
Even theoretically maintained, routine vaccination suffered from the necessary reorganization to transport protective equipment (masks, gloves, hydroalcoholic gel, visors), set up new health security protocols and compensate for the reassignment of personnel to the fight against the Covid-19.
Adding to the usual challenges was confinement, families’ fear of being infected with the coronavirus by bringing their children, and even the suspicion that they were used as guinea pigs to test a future vaccine against Covid-19. Because, on the continent, the violent controversy that erupted after the remarks on the French channel LCI, on April 3, of a researcher from the National Institute of Health and Medical Research (Inserm) and a chief of service of the Cochin hospital, in Paris, wondering about the advisability of testing a vaccine in Africa, had repercussions.
In a survey carried out by Unicef in Côté d’Ivoire “55% of families said they would give up vaccinating their child after this controversy, reveals Doctor Mihigo for whom, cit had a real impact on the French-speaking, but also Portuguese-speaking and English-speaking communities and on the frequentation of health centers which had already declined due to the coronavirus ”. The UN agency for children even had to conduct a specific communication to restore confidence.
But the damage was done. Even if on May 13, UNICEF alerted again by publishing the analysis of a report by researchers from the Johns Hopkins Bloomberg School of Public Health published in Tea Lancet Global Health. ” While [sic] Covid-19 shatters already fragile health systems, more than 6,000 more children under the age of 5 could die every day without immediate action. “
Delays double cohorts of children to be vaccinated
This risk is made all the more evident by the narrow “window of fire”, since most of the first injections of vaccines must be administered during the first year of a baby, at 3, 6 and 9 months of age. “It is always difficult of “catch up” these children, even by widening the vaccinations to 24 months “, explains Anne-Marie Pegg, head of epidemic response and vaccination at Doctors Without Borders (MSF). And the lower the immunization coverage of a country, the more the delays in vaccination and their consequences are passed on the following year, creating an effect ” snowball “.
If national health systems and NGOs have done a lot to adapt, “The preliminary data, which have yet to be analyzed in detail, clearly show a drop in vaccination coverage in April and May”, warns Dr. Mihigo of the WHO. In countries with low vaccination coverage, explains, from Dakar, Gianfranco Flamingi, doctor responsible for vaccination in West Africa and central to UNICEF, delays double the cohorts of children to be vaccinated: “We have to be careful about the numbers, but within a year, we will see epidemics appear with death rates that can climb quickly. Especially since other factors, such as malnutrition, come into play. Vaccination coverage is sufficient to protect the entire population if it reaches 90% of children aged 0 to 11 months. However, only six countries in West and Central Africa reach this figure. “
Catching up will have a high cost at a time when the major players in global health and immunization make no secret of their fear that much of the world’s financial effort will go to research and development of a Covid-19 vaccine.
These difficulties in advancing vaccination coverage, in Africa as elsewhere, pre-existed the Covid-19 crisis. In recent years, a resurgence of epidemics has even been recorded in the north and in the south of the planet. For measles alone, the WHO estimates that nearly 90,000 people, most of them children under the age of 5, died in 2016.
A figure that increased again in 2017 and 2018 with respectively 110,000 and 140,000 deaths mainly in African countries since the most affected were Liberia, Madagascar, the Democratic Republic of the Congo (DRC), Somalia and Ukraine. These five countries alone represent almost half of the world’s measles cases. However, over the past 20 years, significant efforts have been made which have saved more than 23 million lives in measles alone and virtually eradicated polio. Including on the African continent.